Hypertrichosis

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Potassium channel openers Hypertrichosis (minoxidil) lupus-like reactions and pedal edema (hydralazine)... 

Cyclosporine demonstrates immunosuppressive activity by inhibiting the first phase of T-cell activation. It also inhibits release of inflammatory mediators from mast cells, basophils, and polymorphonuclear cells. It is used in the treatment of both cutaneous and arthritis manifestations of severe psoriasis. The usual dose is between 2.5 and 5 mg/kg/day given in two divided doses. Adverse effects include nephrotoxicity, hypertension, hypomagnesemia, hyperkalemia, alterations in liver function tests, elevations of serum lipids, GI intolerance, paresthesias, hypertrichosis, and gingival hyperplasia. Cumulative treatment for more than 2 years may increase the risk of malignancy, including skin cancers and lymphoproliferative disorders. 

Most, if not all, occupational illnesses associated with 2,4,5-T (such as chloracne) have been found to be the result of product contamination with TCDD. TCDD is extremely toxic to animals, and exposure has also been associated with liver function impairment, peripheral neuropathy, personality changes, porphyria cutanea, hypertrichosis, and hyperpigmentation in humans. TCDD is a chlorinated dioxin, one of a large number of related compounds referred to as dioxins it has no functional use and is not intentionally produced. It has been identified as the responsible toxic agent in several industrial disasters, such as accidental releases at Nitro, WV in 1949, and at Seveso, Italy in 1976. " The role of dioxin contaminants must also be considered in the discussion of 2,4,5-T toxicology. 

Adverse reactions may include Stevens-Johnson syndrome pericardial effusion T-wave changes rebound hypertension (following gradual withdrawal in children) decreased initial hematocrit, hemoglobin and erythrocyte counts nausea vomiting temporary edema alkaline phosphatase/serum creatinine/BUN increase, hypertrichosis. 

Triamcinolone Nystatin (Mycolog ) [Anti-inflammatory Antifungal/Corticosteroid] Uses Cutaneous candidiasis Action Antifungal anti-inflammatory Dose Apply lightly to area bid max 25 mg/d Caution [C, ] Contra Varicella systemic fungal Infxns Disp Cream oint SE Local irritation, hypertrichosis, pigmentation changes Interactions T Effects W/barbiturates, phenytoin, rifampin T effects OF salicylates, vaccines EMS See Triamcinolone OD See Triamcinolone... 

For ciclosporin evidence available from small studies is mixed, some suggesting efficacy in inducing remission (at the risk of adverse effects which include neuropathy and hypertrichosis) and others giving little evidence of benefit. 

Dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral... 

Hypertrichosis, hypopigmentation, maceration of skin, miliaria, perioral dermatitis, skin atrophy, striae... 

PO Edema with concurrent weight gain, hypertrichosis (elongation, thickening, increased pigmentation of fine body hair develops in 80% of patients within 3-6 wk after beginning therapy)... 

Tachycardia, palpitations, angina, and edema are observed when doses of 3 blockers and diuretics are inadequate. Headache, sweating, and hypertrichosis, which is particularly bothersome in women, are relatively common. Minoxidil illustrates how one person s toxicity may become another person s therapy. Topical minoxidil (as Rogaine) is used as a stimulant to hair growth for correction of baldness. 

Minoxidil Metabolite opens channels in vascular smooth muscle Minoxidil Hypertrichosis... 

Exacerbation of pre-existing rosacea Hypertrichosis of the face Atrophic changes... 

The use of unoprostone in the treatment of open-angle glaucoma and ocular hypertension has been reviewed (1). Most of the literature is in Japanese. The adverse effects of unoprostone are similar to those of latanoprost conjunctival hyperemia, iris pigmentation, hypertrichosis and hyperpigmentation of eyelashes, and rarely systemic effects (1). 

Tamoxifen has several adverse effects on the skin, including edema, flushing, rashes, hyperhidrosis, urticaria, alopecia, and hypertrichosis. Radiation recall dermatitis, a severe painful inflammatory skin reaction in sites that have previously been exposed to ionized radiation, can occur in patients taking tamoxifen (59). In one case the tamoxifen was withdrawn and the skin healed spontaneously in 7 weeks (60). Toremifene, a tamoxifen analogue, was well tolerated during 18 months of continuous treatment no signs of radiation recall developed. 

In conclusion, dermal effects, particularly chloracne, are the most commonly reported effects of 2,3,7,8-TCDD exposure in humans because they are easy to identify. Additional information is needed to determine the level and frequency of 2,3,7,8-TCDD exposure needed to cause chloracne and whether individual susceptibility plays a role in the etiology. Also, chloracne in humans indicates CDD exposure, but lack of chloracne does not indicate that exposure has not occurred. Other dermal conditions reported include hypertrichosis, hyperpigmentation, and solar elastosis. 

VASODILATOR ANTIHYPERTENSIVES CICLOSPORIN 1. Co-administration of bosentan and cidosporin leads to t bosentan and 1 cidosporin levels 2. Risk of hypertrichosis when minoxidil given with cidosporin 3. t sitaxentan levels 1. Additive effect both drugs inhibit the bile sodium export pump, which is associated with hepatotoxicity 2. Additive effect 3. Uncertain 1. Avoid co-administration of bosentan and cidosporin 2. Warn patients of the potential interaction 3. Avoid co-administration... 

Iris color darkening Increased eyelid pigmentation Hypertrichosis Conjunctival hyperemia Allergy... 

Minoxidil is a vasodilator selective for arterioles rather than for veins, similar to diazoxide and hydralazine. Like the former, it acts through its sulphate metabolite as an ATP-dependent potassium channel opener. It is highly effective in severe hypertension, but causes increased cardiac output, tachycardia, fluid retention and hypertrichosis. The hair growth is generalised and although a cosmetic problem in women, it has been exploited as a topical solution for the treatment of baldness in men. 

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